Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

geopolitics sceneries and military roles in the South America

O presente trabalho trata do emprego das Forças Armadas dos países da América do Sul levando em consideração o panorama geopolítico pós-Guerra Fria. Dois são os objetivos principais: estabelecer cenários geopolíticos para o subcontinente com base em diferentes paradigmas da Teoria das Relações Internacionais e, a partir desses cenários, analisar o emprego das Forças Armadas na América do Sul diante das atuais características geopolíticas. Considera-se como recorte temporal, para tal estudo, o período compreendido entre o fim da Guerra Fria e os dias atuais e, como recorte espacial, a escala subcontinental. Por meio de uma abordagem plurimetodológica, analisa-se o sentido geopolítico das iniciativas de cooperação e integração militar entre os países sul-americanos fenômeno que, em virtude da autonomia de que ainda dispõem os meios militares na região, ocorre de forma paralela às demais dimensões do processo de integração regional. Adotando uma perspectiva construtivista de abordagem das Relações Internacionais, procura-se, também, analisar a possibilidade de construção no subcontinente de uma Comunidade de Segurança. Por fim, em caráter meramente prospectivo, procura-se analisar as possibilidades de emprego das Forças Armadas na América do Sul considerando quatro diferentes cenários: clássico (escala nacional), construtivista (escala regional), hegemônico (escala hemisférica) e idealista (escala global).This work concerns the use military roles of South American countries, taking into consideration the post-Cold War geopolitic panorama. There are two main objectives: stablish geopolitic sceneries for the subcontinent based on different International Relations Theory paradigms and, to from these sceneries, analyse the function of the Forces in the South America faced the present geopolitic characteristics. This study considers the period between the end of Cold War and the present days, having as spatial setting the subcontinental scale. Through a plurimethodological approoch, this work analyses the geopolitical meaning of military cooperation and integration initiative in the South American countries phenomenon that has been a parallel process of regional integration due to military forces autonomy. By means of constructivist perspective of International Relation Theory also analysing the possibility of constucting a Security Community in the subcontinent. At last, under a prospective character it analyses the possibility of the military forces appliance in the South America, considering four different sceneries: classic (national scale), constructivist (regional scale), hegemonic (hemispheric scale) and idealist (global scale)

Between deterrence and cooperation: security policies and military perception in South America

O presente estudo trata da dimensão militar do processo de integração regional na América do Sul. Com foco no papel das percepções das agências de defesa (exércitos nacionais), são analisadas possibilidades de tratamento cooperativo para questões de defesa e segurança na região. Do ponto de vista das Relações Internacionais, a América do Sul se constitui numa região historicamente marcada por um paradoxo: estabilidade externa e instabilidade interna. Com o processo de redemocratização nos anos 1980, cogitou-se o surgimento de uma comunidade de segurança pluralística na região. Ao longo das últimas décadas, porém, o processo de integração regional tem sido marcado pela coexistência de sinais de integração e de fragmentação e tem-se mostrado espacialmente irregular: ao mesmo tempo em que o Cone Sul emite sinais de aproximações estratégicas, persistem, especialmente no canto noroeste do subcontinente, antigas desconfianças e zonas potenciais de conflitos territoriais clássicos. Tendo esse cenário como pano de fundo, o trabalho busca testar evidências de mudanças de padrões culturais no Sistema Internacional e de alterações na identidade de agentes estatais. Para tal, possui um caráter interdisciplinar e plurimetodológico, numa abordagem que envolvesse diferentes campos do conhecimento: Ciência Política, Sociologia, Teoria das Relações Internacionais e Geografia Política. Adotando uma perspectiva construtivista, busca-se analisar o papel das percepções e das identidades no contexto regional sul-americano, tomando-se os militares como atores centrais. Os dados analisados se baseiam em fontes diversas: políticas de defesa; entrevistas realizadas com oficiais de países da região, questionários aplicados a oficiais e alunos de escolas militares do Exército Brasileiro em diferentes níveis de formação etc. Apesar de haver evidências de que as alterações geopolíticas ocorridas ao longo das últimas décadas contribuíram para diluir estoques de desconfiança, repercutindo positivamente na forma como os militares percebem o processo de cooperação regional, persistem na região fortes sinais de ameaça mútua, especialmente nos países andinos, o que caracteriza o dilema entre a dissuasão e a cooperação na América do Sul.The current study aims at the military dimension of regional integration process in South America. Focusing at the role of perceptions of the defense agencies (National Army) can have on such process, we analyze possibilities of cooperative treatment regarding defense and security in the region. From the point of view of International Relations, South America appears as a region historically marked by a paradox: external stability and internal instability. Having the democratization process in the 80s as a starting point, some authors have considered the South America as a region where a pluralistic security community starts to emerge. Throughout the last two decades, however, the process of regional integration has been marked by the coexistence of signs of integration and fragmentation. The process is also spatially irregular: while the Southern Cone shows signs of strategic approaches, persist, especially the northwest corner of the subcontinent, old suspicions and potential areas of territorial conflict. Taking this scenario as a background, the study seeks to test evidence of changes in cultural patterns in the International System and changes in the identity of State agents. This is an interdisciplinary and multimethodological study and we used an approach that has involved different fields of knowledge: Political Science, Sociology, International Relations Theory and Political Geography. Adopting a constructivist perspective, we seek to analyze the role of perceptions and identities in the regional context, taking the military as central actors. The data analyzed are based on several sources of research: defense policy, interviews with officials from the region, questionnaires to officers and students from military schools of the Brazilian Army, etc. We conclude that there is evidence that, among the Southern Cone countries, the geopolitical changes which have occurred over the past decade have contributed to dilute stocks of mistrust, impacting positively on the military perceptions. However, the process of regional cooperation between Andean countries strong suspicions still remain. Such fact contributes to characterize the dilemma between deterrence and cooperation and affects the perception of the military in the regio

A South American Defence Structure: Problems and Prospects

Abstract This article discusses the process of building a South American defence architecture over the past two decades, culminating in the formation of the South American Defence Council (Consejo de Defensa Suramericano, or CDS). It discusses the main proposals for a regional security mechanism, primarily made by Brazil and Venezuela, analyses the debates around them, and characterises them as different models of regionalism, namely a pluralistic and amalgamated model. I argue that the differences between these models, and the different agendas underpinning them, constitute obstacles to the progress of regional co-operation and integration in the military field. Other obstacles include the overlap of regional defence initiatives, the different options for operationalising ‘extra-regional deterrence’, the relationship between regional countries and extra-regional actors, the inclusion of security issues in the CDS agenda, and the idea of demilitarising borders